Hospitals Face Pressure to Avert Readmissions

 The New York Times

 By JORDAN RAU

Published: November 26, 2012

After years of gently prodding hospitals to make sure discharged patients do not need to return, the federal government is now using its financial muscle to discourage readmissions.

Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare’s regular payments for every patient over the next year, federal records show.

One of those is Barnes-Jewish Hospital in St. Louis, which will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”

The crackdown on readmissions is at the vanguard of the Affordable Care Act’s effort to eliminate unnecessary care and curb Medicare’s growing spending, which reached $556 billion this year. Hospital inpatient costs make up a quarter of that spending and are projected to grow by more than 4 percent annually in coming years, according to the Congressional Budget Office.

The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they walk out the door. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries.

“I’ve been doing this for over two decades and talking to hospital leaders about readmissions, and I used to get polite but blank stares,” said Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised widely adopted methods to reduce hospitalizations. “Now they’re paying attention.”

With nearly one in five Medicare patients returning to the hospital within a month — about two million people a year — readmissions cost the government more than $17 billion annually.

Hospitals’ traditional reluctance to tackle readmissions is rooted in Medicare’s payment system. Medicare generally pays hospitals a set fee for a patient’s stay, so the shorter the visit, the more revenue a hospital can keep. Hospitals also get paid when patients return. Until the new penalties kicked in, hospitals had no incentive to make sure patients didn’t wind up coming back. The maximum penalty is set to double next October and then reach 3 percent of reimbursements in October 2015. Medicare also is expanding the list of conditions it will assess in setting punishments.

Right now it only evaluates readmissions of heart attack, heart failure and pneumonia patients, counting every rebound, even ones not related to the original reason for hospitalization. The penalties are based on readmission rates in the past and applied to future payments for all Medicare patients.

Researchers say that while some readmissions are unavoidable, many are caused by the short shrift hospitals have given patients on their way out.

Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services, said the penalties had helped galvanize hospitals’ efforts to avoid readmissions. “We’ve seen a small but significant reduction,” he said. “That tells me we’ve focused the industry on improvement.”

Medicare’s tough love is not going over well everywhere. Academic medical centers are complaining that the penalties do not take into account the extra challenges posed by extremely sick and low-income patients. For these people, getting medicine and follow-up care can be a struggle.

At Barnes-Jewish Hospital, Dr. Lynch said physicians from all over the Midwest referred their sickest heart patients to his facility for transplants and other major interventions. But those patients can skew his hospital’s readmissions numbers, he said: “The weaker your heart, the more advanced your emphysema, the more likely you are to be readmitted to the hospital.”

Dr. Lynch said Barnes-Jewish set up follow-up appointments for patients who didn’t have their own doctors. But about half of the patients never showed up, he said, even after the hospital made reminder phone calls and arranged for free rides. Sending nurses to see patients at home did not significantly reduce readmission rates either, he said.

“Many of us have been working on this for other reasons than a penalty for many years, and we’ve found it’s very hard to move,” Dr. Lynch said. He said the penalties were unfair to hospitals with the double burden of caring for very sick and very poor patients.

“For us, it’s not a readmissions penalty,” he said. “It’s a mission penalty.”

Various studies, including one commissioned by Medicare, have found that the hospitals with the most poor and African-American patients tended to have higher readmission rates than hospitals with more affluent and Caucasian patients. But the studies also determined that some safety-net hospitals performed better than average, showing that hospitals can overcome the challenges posed by the kinds of patients they treat.

In some ways, the debate parallels the one on education — specifically, whether educators should be held accountable for lower rates of progress among children from poor families.

“Just blaming the patients or saying ‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong,” said Dr. Harlan Krumholz, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, which prepared the study for Medicare. “I’ve got to believe we can do much, much better.”

Some researchers fear the Medicare penalties are so steep, they will distract hospitals from other pressing issues, like reducing infections and surgical mistakes and ensuring patients’ needs are met promptly. “It should not be our top priority,” said Dr. Ashish Jha, a professor at the Harvard School of Public Health who has studied readmissions. “If you think of all the things in the Affordable Care Act, this is the one that has the biggest penalties, and that’s just crazy.”

With pressure to avert readmissions rising, some hospitals have been suspected of sending patients home within 24 hours, so they can bill for the services but not have the stay counted as an admission. But most hospitals are scrambling to reduce the number of repeat patients, with mixed success.

A few days after Eda Laurion was discharged from the Banner Del E. Webb Medical Center near Phoenix after treatment for her congestive heart failure in August, a nurse showed up at her house.

“She helped explained the medicines I’m taking, the side effects, what they do for you,” said Ms. Laurion, 91, of Sun City West.

Still, readmissions can’t always be prevented. The nurse, Sue Koner, sent Ms. Laurion back to the hospital after two weeks for dangerously low sodium caused by an undiagnosed kidney problem. However, Ms. Laurion avoided re-hospitalization in October when Ms. Koner deduced that her hallucinations were a reaction to an antibiotic.

Overseeing former patients is expensive and time-consuming, so many hospitals are relying on financing from community health organizations and foundations. Ms. Koner works for Sun Health, a foundation-supported nonprofit. Since Sun Health started its program in November 2011, only nine of 213 patients have been readmitted.

Dr. Krumholz said hospitals should think of readmissions as a challenge to overcome. “One day, we’ll look back,” he said, “and we’ll be incredulous that one out of every five patients ended up back in the hospital.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

A version of this article appeared in print on November 27, 2012, on page D1 of the New York edition with the headline: Hospitals Face Pressure To Avert Readmissions.

Link: http://www.nytimes.com/2012/11/27/health/hospitals-face-pressure-from-medicare-to-avert-readmissions.html?_r=0

GAO: Less than 4 percent of Medicaid beneficiaries had difficulty receiving care

By Chris Anderson, Senior Editor

WASHINGTON – A new report from the Government Accountability Office (GAO) found that less than 4 percent of Medicaid beneficiaries who had coverage for at least a year reported difficulty obtaining medical care in 2008 and 2009, this despite more than two-thirds of states reporting they faced challenges in ensuring there are enough Medicaid providers to serve the growing number of beneficiaries.

Medicaid beneficiaries who had coverage for less than a year, however, were much more likely to have difficulty obtaining healthcare, and more than 5 percent reported difficulty in getting dental care. The Medicaid report by GAO, which was provided to the U.S. Department of Health and Human Services, was intended to determine if states are providing adequate access to medical care to Medicaid recipients as enrollment has grown over the past few years, and is expected to grow by as many as 11 million as a result of health reform.

Thirty-eight of the 55 states and territories reported challenges in ensuring there were enough doctors participating in their program to ensure adequate delivery of care to Medicaid members.

“In general, states attributed these challenges to a shortage of providers and Medicaid payment rates, but also cited other issues, such as missed appointments and administrative burden, as factors that influenced provider participation,” the reported noted. “States reported efforts to simplify administrative processes to retain and attract Medicaid providers and, to a lesser extent, reported efforts to increase payment rates or other financial incentives.”

Providing dental care was the most common service area reported as being a challenge, cited by 30 of the states and territories. Twenty-six reported challenges providing specialty care for Medicaid patients, with 17 each saying alcohol and substance abuse care and primary care also presented challenges.

The research finding mirrors those of other published reports, the GAO said, that provider payment rates strongly influence decisions on whether to participate in the program. But, other studies have shown that while provider payment rates are a strong influence on the decision, it was not the sole driver of the decision.

“According to this study, other factors such as the structure of the practice and Medicaid administrative requirements can affect the decision to participate as well,” the report authors wrote.

Not surprisingly, then, 38 states also reported making payment or other administrative changes in their Medicaid programs in an effort to increase provider participation. The most common changes made, in addition to increased payments, were streamlined enrollment methods, increased speed in processing claims and reduced administrative burden for processing claims.
 


Source URL: http://www.healthcarefinancenews.com/news/gao-less-4-percent-medicaid-beneficiaries-had-difficulty-receiving-care

State lawmakers gird for battle over Medicaid expansion

By N.C. Aizenman, Published: December 2

As state legislatures prepare to meet in January, lawmakers across the country are girding for a battle over whether to sign on to the health-care law’s expansion of Medicaid.

“This is the number one issue,” said state Sen. Michael Lamoureux (R), incoming president of the Arkansas Senate. “And in 10 years this is by far the most difficult one we’ve ever dealt with.”

The national implications loom just as large. No provision is more central to achieving the health-care law’s aim of extending coverage to the uninsured than its expansion of Medicaid. Under the new rules, beginning in 2014 eligibility for the program would be opened to people with incomes up to 133 percent of the federal poverty level, or about $30,657 for a family of four.

The law calls for the federal government to foot the the entire bill for covering the newly eligible for the first three years. After that the federal match phases down slightly, reaching 90 percent by 2020.

Arkansas state Sen. Cecile Bledsoe (R) questions whether the federal government can be counted on to maintain such a high match rate in perpetuity. With all the budget pressures facing Congress members, said Bledsoe, how can she be sure they won’t shift more of the burden to states down the road?

Last August Obama officials sought to allay such concerns by clarifying that states are free to drop out of the Medicaid expansion at any time. But Bledsoe, a key leader in the Arkansas Senate on health issues, said that’s not a realistic option.

“We’re not going to put more than 250,000 people on our Medicaid rolls, then pull them off,” she said.

Bledsoe said she will not feel confident about the federal commitment at least until after Obama concludes negotiations with congressional Republicans over avoiding the “fiscal cliff.”

“At this point I don’t see anyone willing to take a chance on what the federal government might or might not do,” she said.

With barely a year before the expansion is scheduled to begin, only 14 states seem certain to join in. About 13 states seem likely to opt out because the GOP has a lock on both the governors’s office and the legislature and many of these Republicans are dubious of expansion. But even here the outcome is often in doubt. For instance, Florida’s Gov. Rick Scott (R) has been one of the most scathing critics of expanding Medicaid. But in an interview shortly after the election, Scott suggested he was open to trying to “get to yes” on the issue.

Meanwhile, in more than a third of states, governors and state lawmakers have been so vague about their intentions, or so at odds, that it is impossible to predict how the debate will play out.

In Colorado, where Democrats hold both the legislature and the governor’s mansion, the challenge is less ideological than practical. State revenue is not expected to rise fast enough to cover the extra cost of enlarging Medicaid in coming years. And the state constitution prohibits lawmakers from raising taxes without a voter referendum.

They could find that the only way to make up the difference is through unpopular cuts to spending on education — one reason Gov. John Hickenlooper (D) has so far been noncommittal.

“We’re in a fiscal straitjacket,” concedes Rep. Claire Levy (D), the House’s point person on budget matters.

The Supreme Court teed up these conflicts last June, when it ruled that states can’t be penalized for opting out of the Medicaid expansion.

This effectively threw the decision to each state’s general assembly: Because Medicaid is partly funded by states, one way or another lawmakers will be forced to address the issue when crafting their budgets for 2014.

Arkansas Gov. Mike Beebe (D) has pushed hard for his state to participate in the expansion. But he always faced a tough sell in his state, one of three where a super-majority is required to pass budget bills. And the hurdle has only gotten higher since last month’s elections, when Republicans won control of Arkansas’s General Assembly for the first time since Reconstruction.

Even if the federal match rate for Medicaid is left untouched during the current fiscal cliff talks, Lamoureux, the incoming Arkansas Senate president, said he worried his state will be unable to afford its share of the cost of expansion.

The nonpartisan Kaiser Family Foundation estimates the additional charge to Arkansas will be almost $1 billion from 2013 through 2022. And, although Arkansas’s Medicaid director, Andrew Allison, suggests the administrative costs of expansion will be modest, and it could actually save the state money on uncompensated care for the uninsured, Lamoureux wants more detailed numbers.

“We don’t even have an agreed upon set of facts that we can fight over yet,” he said.

Like many state lawmakers, Lamoureux also argues that his state’s governor could negotiate with Obama officials for permission to do only a partial expansion of Medicaid — getting the full federal match to insure people with incomes only up to 100 percent of poverty, for instance, with the remainder getting coverage through the law’s federal subsidies to buy private plans.

However, health-care experts question whether Obama officials have the legal authority to authorize partial expansions — let alone whether they would agree to them.

“There is almost no reason whatsoever for the administration to want to do this,” said Matt Salo, executive director of the National Association of Medicaid Directors.

“And I think the only thing that would change that calculus is if you have a significant number of states that are really dead serious that if you give them the choice between full expansion or nothing, they will choose nothing.”

That may explain why the administration has yet to declare whether partial expansion is, or is not, an option, Salo added.

Yet paradoxically, by keeping the idea on the table, Obama officials may only be prolonging the debate — particularly since there is no formal deadline by which states must opt in to the Medicaid expansion, and states would probably need only weeks rather than months to prepare.

“Right now you have the states and the federal government kind of circling each other warily,” Salo said. “No one is quite ready to tip their hand.”

.

Medicare beneficiaries reach $5 billion in drug savings

7:45 AM, December 3, 2012  |  

By Kelly Kennedy

USA Today

 

Since passage of the health care overhaul two years ago, 5.8 million Medicare patients have saved $5 billion from prescription drug discounts, and the government can now predict lower health care costs based on increased use of these cheaper drugs.

The savings are a continuation of the 2010 health care law’s attempt to close the “doughnut hole” — or the prescription drug coverage expenses that kick in once Medicare coverage runs out. The Department of Health and Human Services plans to announce those savings today.

“The health care law is saving money for people with Medicare,” said HHS Secretary Kathleen Sebelius, before adding that open enrolling begins next week.

In 2012, Medicare coverage ends when total prescription costs top $2,930. Drugmakers participating in Medicare agreed to give the government a 50% discount on premiumdrugs and 14% on generic drugs as part of the health care law, and to extend those discounts to seniors who have exhausted their coverage and are forced to pay for the drugs themselves.

Because of these discounts, in the first 10 months of 2012, Medicare beneficiaries saved $1.86 billion on prescription drugs, compared with $1.51 billion in the first 10 months of 2011, according to HHS. The last months of the year tend to have higher savings as people run out of coverage and enter the doughnut hole.

The Congressional Budget Office announced an added benefit Thursday: Cheaper drugs means more people taking their medication, reducing long-term medical costs. When Medicare patients take an antibiotic to prevent further infection, or properly take their insulin or hypertension medications, they save the government money in the long run by stabilizing their illnesses and preventing emergency hospitalizations.

“Using the revised methodology, CBO estimates that the net cost of implementing the provisions closing the coverage gap will be $51 billion, rather than the $86 billion estimated prior to the revision,” the CBO report states.

But Michael Cannon, director of health policy studies for the Cato Institute, a libertarian think tank that has come out against the AffordableCare Act, said that as “politicians and lobbyists” expand the drug benefits, more people who don’t need them use them, and “health care spending rises.”

“It’s an attractive story: New government subsidies lead more people to take their medicine, leading to lower health care spending,” he said. “Problem is, it’s almost never true.”

Cato has also argued that lowering the prices of name-brand medications will steer seniors away from generic drugs, thus causing the government more money.

That may not be the case. Before the doughnut-hole discounts started, customers would learn their benefits had run out and stop taking their more expensive medications, said Steve Simenson, president of Goodrich Pharmacy and past president of the American Pharmacists Association. His store caters to hundreds of patients each day, he said.

Now, however, more customers are taking advantage of generic medication — even on the government’s dime — so their coverage lasts longer, Simenson said.

“They’re asking for them,” he said. “I’m not sure they know it’s because of the Affordable Care Act. They’re still not quite educated on the nuts and bolts of the benefits.”

Ultimately, they see a difference, even if they don’t know where the benefit comes from, he said: “Better adherence leads to better outcomes.”

Previous CBO reports did not list the financialbenefits of patients taking affordable prescription medications, because there was insufficient evidence of an “offsetting” effect. On Thursday, the office said every 1% increase in prescriptions filled by Medicare patients would cause the program’s spending to drop by one-fifth of 1%.

The change in policy came after dozens of studies and research showed a link between changes in prescription use and in spending for medical services, according to the CBO.

“A substantial body of evidence indicates that people respond to changes in cost sharing by changing their consumption of prescription drugs,” CBO stated in their report.

Critics of the law had warned that Part D premiums would go up, as would medications for non-beneficiaries as drug companies tried to make up for the loss in profits in from the discounts. However, premiums have stayed stable, and the Government Accountability Office, the non-partisan watchdog arm of Congress, found that prices for brand-name drugs used by Medicare beneficiaries increased at a similar rate before and after the government required discounts in January 2011.

Article Link: http://www.freep.com/article/20121203/BUSINESS07/121203016/Medicare-beneficiaries-reach-5-billion-in-drug-savings

Health Insurance Exchanges: More Questions, Some Answers

Courant.com

By WILLIAM WEIR, bweir@courant.com

6:45 PM EST, November 28, 2012

Health insurance exchanges, set to begin in 2014, are an entirely new thing for the state, so there are still a lot of questions, not all of which have answers yet.

About 120 people showed up for the first informational public meeting on the topicTuesdayin Hartford, with a number of questions about how the exchange will work. Who it will most benefit? How will the exchanges affect price? What services will be provided?

The second informational meeting takes place Thursday at Veterans Memorial Hall in Waterbury Hall.

What are exchanges?

Exchanges, mandated by national health care reform, are online markets where consumers can choose from various health plans. The plans will be federally subsidized for those who meet income requirements. All states must have in place a health insurance exchange in place by 2014.

Who will use them?

That remains to be seen, but there are some likely candidates. About 180,000 people in Connecticut now buy insurance on their own. The exchange will allow them to more easily “shop for a better deal or at least give them a better array of choices,” said Jason Madrak, spokesman for the Connecticut Health Insurance Exchange, a quasi-public agency run by a 14-member board. In addition, about 350,000 state residents are uninsured.

“If we can get half of those people, we’d be happy,” Madrak said. The goal, he said, is to reduce the uninsured rate in the state from 10 percent to about 5 percent the first year, to 2 percent the following year, and then “near zero percent.”

If you are an employee at a company that offers insurance, you could opt out of that plan and shop around in the exchange. “Obviously, you’d want to do the math,” Madrak said. Your employer is under no obligation to contribute.

As for businesses, he said, “the biggest benefit is to small companies” — specifically those of 50 employees and fewer. But Madrak said that in states with exchanges already in place, very few businesses participate.

With more people having access to health care, will there be enough doctors?

“To be very frank with you, I don’t think anyone knows the answer to that,” Kevin Counihan, CEO of the Connecticut Health Insurance Exchange, said at Tuesday’s informational meeting. He said the shortage of primary care physicians is a state and national issue.

Dr. Keith vom Eigen, a professor of medicine at University of Connecticut and a panelist at Tuesday’s meeting, said the expected increase in demand will take a while.

“It’s going to be a challenge,” he said. “Right now our system is not set up to turn out a primary care workforce.”

Currently, the market offers more lucrative rewards for specialists and subspecialists.

“Students know when they come out [of medical school] where they can make the most money and where they can have the most satisfying lifestyle, and currently it’s not primary care,” vom Eigen said. “We’re hoping that demand for primary care will shift the market, but it’s going to take time.”

Counihan said that when Massachusetts passed its own health care reform in 2006 — a move that reduced the number of uninsured from 700,000 to about 190,000 — primary care physicians were stretched thin. What happened, he said, was that physician assistants, licensed practical nurses and registered nurses began take on much of the workload.

“This actually freed up the primary care physicians to work on a bit more sophisticated kind of work,” he said.

What if employers choose to pay a fine instead of covering employees?

Under the Affordable Care Act, also known as Obamacare, companies that employ more than 50 people must either offer coverage or pay a fine, which starts at $2,000 per employee. Counihan said it is impossible to know how employers will react to the changes, but pointed again to the example of Massachusetts. Before the state moved to an exchange system, he said, 70 percent of companies in that state offered coverage. After a few years, 77 percent offered coverage. The fine for not doing so was $250 per employee.

How much will health plans cost?

Consumers won’t see the actual plans and prices until close to October 2013, when open enrollment begins. With the Affordable Care Act, families that earn less than 400 percent of the poverty level will be eligible for federal subsidies that will reduce the costs of insurance premiums — how much depending on their income.

Will exchanges lower insurance costs?

Exchanges are designed to create competition among companies, which theoretically will lead to lower costs. It is unknown now how many companies will participate in the exchange, but the board of directors of the Connecticut Health Insurance Exchange has said it is trying to make their plans as appealing to companies as possible. Madrak said “all the expected” companies have expressed interest in participating.

Will the exchange make costs more transparent?

One audience member at Tuesday’s meeting expressed his frustration at trying to get providers to tell him beforehand the cost of a particular service. He wanted to know if the exchange will provide specific cost-per-service information.

Counihan said he agreed that there needs to be more transparency. “Within our own state there could be a wide variation of prices for the same procedure.” But as far as providing costs for each service, he said, “we’re not there yet.”

Another panelist, Alta Lash, executive director of United Connecticut Action for Neighborhoods and a member of one of the exchanges advisory boards, said the exchange needs to be structured to help the consumer make informed choices.

Counihan said he expects the exchange will make shopping for insurance easier; he compared it with online services such as Travelocity and Expedia, which list items from cheapest to most expensive.

“That’s the kind of experience you’ll be seeing,” he said. “It’s going to be clearer, it’s going to be more understandable and hopefully it’s going to be a much more satisfying experience for people shopping for coverage.”

Thursday’s informational meeting is at Waterbury City Hall, 235 Grand St., Room 225, from 5:30 p.m. to 7 p.m.

Copyright © 2012, The Hartford Courant

 

Article Link: http://articles.courant.com/2012-11-28/health/hc-insurance-exchanges-1129-20121128_1_health-insurance-exchanges-jason-madrak-kevin-counihan

Primary care benefits may blunt impact of rising deductibles

Employers are trying to balance reducing health costs with federal mandates and corporate interest in increasing access to well care.

By VICTORIA STAGG ELLIOTT, amednews staff. Posted Nov. 26, 2012.

Although patients with work-sponsored insurance plans are having to pay more out of pocket to see a doctor, experts say that might not indicate, as it did in the past, that they will try to avoid medical care for as long as possible.

Deductibles are going up, but a higher proportion of plans provide coverage of primary care office visits without patients having to meet those deductibles, according to a Nov. 12 brief from the Kaiser Family Foundation, which gathered data from 2,121 companies with three staffers or more. In addition, the Affordable Care Act requires many insurance plans to cover preventive services with no out-of-pocket cost to a patient. Many of these services are provided in the primary care setting.

 “It’s a smart insurance design,” said Cathy Schoen, senior vice president of the Commonwealth Fund. “You want to encourage people to get preventive care, and primary care visits are not very expensive. You want patients to stay connected to primary care.”

Deductibles continue to grow because companies are trying to hold down premiums, according to the Kaiser brief. The average deductible for individual coverage went up from $991 in 2011 to $1,097 in 2012, a total that has nearly doubled since 2006. The percentage of workers in a individual-coverage plan with a general annual deductible of at least $1,000 for individual coverage grew from 31% in 2011 to 34% in 2012, a total that has more than tripled since 2006. The proportion with an annual general deductible for individual coverage of $2,000 or more went from 12% in 2011 to 14% in 2012, a total that has gone up almost five times the percentage of 2006.

However, having to meet a deductible during the past few years has become a less common issue in access to primary care services, both for prevention and illness care. The percentage of covered workers in an HMO plan with no deductible for those visits grew from 77% in 2008 to 84% in 2011, and up to 87% in 2012. PPO plan holders had seen their first-dollar preventive services coverage fall from 76% in 2008 to 70% in 2010, but that number increased to 78% in 2012.

Between the ACA and employers’ desire to get workers in for lower-cost primary care services, rather than letting them wait to see a doctor until they are really sick, the goal is for deductibles to reduce health care costs without blocking people from what they actually need. For instance, an analysis in the May issue of Health Affairs found that high-deductible plans could lower the cost of outpatient care by 18.2% but also cut cervical cancer screening by 4.7% and colorectal cancer testing by 2.8%.

Although deductibles are increasing, the percentage of workers with employer-sponsored, individual-coverage health insurance involving any general annual deductible dropped slightly to 72% in 2012 from 74% in 2011. The number had grown from 52% in 2006. Kaiser researchers say it is too soon to determine whether the slight decline from 2011 to 2012 is a plateau or an indication that general deductibles will become less common over the long term. Consultants believe the number of companies offering this type of insurance may have maxed out, along with the number of employees willing to sign on.

Most companies are expected to continue to offer health insurance to employees as health system reform rolls out. Eighty-eight percent said they had no plans to end health care plans for full-time workers, according to a survey of 440 companies with 6.6 million employees released on Aug. 27 by Towers Watson, a global human resources consulting firm, for the National Business Group on Health. This represented an increase from the 71% who said the same in 2011.

Consultants said these workplace insurance trends may accelerate the return of patients to primary care practices. Various surveys have found physician office visits slowly ticking upward after they fell in 2010 and 2011 as the economy recovered from the deep recession of December 2007 to June 2009.

What percentage of insured employees pay deductibles?

Providing workers health insurance with a general annual deductible has become much more common as companies look for ways to contain premium costs. Growth slowed during the past few years, according to a recent analysis by the Kaiser Family Foundation.

Year Workers in plans

with a deductible

2006 52%
2007 56%
2008 57%
2009 62%
2010 69%
2011 74%
2012 72%

Source: “The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey,” Kaiser Family Foundation, Nov. 12 (kff.org/insurance/snapshot/chcm110212oth.cfm)

 

Primary care: Removed from the deductible

Companies increasingly are providing coverage for primary care services without having to meet a deductible. The Affordable Care Act requires most insurance plans to cover preventive services without cost sharing. The percentage of workers with general annual deductibles who have coverage for primary care office visits without a deductible applying, by plan type:

Year HMO PPO POS
2008 77% 76% 78%
2009 84% 74% 74%
2010 83% 70% 81%
2011 84% 74% 68%
2012 87% 78% 79%

Source: “The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey,” Kaiser Family Foundation, Nov. 12 (kff.org/insurance/snapshot/chcm110212oth.cfm)

What employees pay before insurance kicks in

As companies try to hold down premium costs, their employees continue to pay higher deductibles to make up the difference. Average deductibles for employees with individual coverage by type of plan:

Year HMO PPO POS HDHP/

savings

All plan

average

2006 $352 $473 $553 $1,715 $584
2007 $401 $461 $621 $1,729 $616
2008 $503 $560 $752 $1,812 $735
2009 $699 $634 $1,061 $1,838 $826
2010 $601 $675 $1,048 $1,903 $917
2011 $911 $675 $928 $1,908 $991
2012 $691 $733 $1,014 $2,086 $1,097

Source: “The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey,” Kaiser Family Foundation, Nov. 12 (kff.org/insurance/snapshot/chcm110212oth.cfm)

The growing health cost burden on workers

Deductibles have been growing for years, and high-deductible plans have become more common as companies look for ways to rein in health care costs. The percentage of workers with individual coverage and a general annual deductible of $1,000 or $2,000, or more:

Year $1,000

deductible

$2,000

deductible

2006 10% 3%
2007 12% 3%
2008 18% 5%
2009 22% 7%
2010 27% 10%
2011 31% 12%
2012 34% 14%

Source: “The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey,” Kaiser Family Foundation, Nov. 12 (kff.org/insurance/snapshot/chcm110212oth.cfm)

WEBLINK

“Growth Of Consumer-Directed Health Plans To One-Half Of All Employer-Sponsored Insurance Could Save $57 Billion Annually,” Health Affairs, May (content.healthaffairs.org/content/31/5/1009.abstract)

“The Prevalence and Cost of Deductibles in Employer Sponsored Insurance: A View from the 2012 Employer Health Benefit Survey,” Kaiser Family Foundation, Nov. 12 (www.kff.org/insurance/snapshot/chcm110212oth.cfm)

Article Link: http://www.ama-assn.org/amednews/2012/11/26/bisb1126.htm

Copyright 2012 American Medical Association. All rights reserved.

 

Medical News for You presenting multiple town halls to explain Louisville-region Medicaid changes

By TERRY BOYD | Published: NOVEMBER 21, 2012

 

Medical News for You staffers will conduct a series of town hall meetings across the Louisville region to help members navigate on-going changes to Medicaid for Region 3.

It’s Medical News to You to the rescue as Kentucky’s Medicaid Meltdown continues.

“Most importantly, we are trying to help people understand that no matter what they hear, they have a choice in their new plan including a choice to remain with Passport Health Plan,” said Ben Keeton, MN4U publisher.

The region, which is the largest and most populous of the state’s eight Medicaid regions, includes about 170,000 Medicaid members in Jefferson and 15 surrounding counties. Until now, Region 3 has been the purview solely of Louisville-based Passport Health Plan. Last May, state officials issued requests for proposals for Passport’s region saying the federal government was ordering them start to increase competition in the Medicaid managed care space.

The basic message is, Keeton said, ” ‘This isn’t the end of the world.’ We want to educate people on changes in Medicaid so they can make the best decision for their family. They’re not stuck with the plan the state assigns them.”

In addition to Passport, the new MCOs for Region 3 are Coventry Health Care, based in Bethesda, Md., WellCare Health Plans based in Tampa, Fla. and Louisville-based Humana, with patients initially divvied up between plans via an assignment algorithm.

In the town halls, MN4U staff will walk attendees through the selection process including the relative advantages of each Medicaid managed care plan, Keeton said.

“We want to encourage people to make sure they look at the provider networks. What the plans actually cover – the benefit summary and the pharmacy benefits.”

The first Medicaid town hall is scheduled for Sunday, Dec. 9, after services at St. Stephens Church at 1018 S. 15 St.

The MN4U staff doesn’t have a set number of total town halls in mind.

But they will conduct meetings in all 16 Passport counties – five in Jefferson County – which would require at least 20 events in libraries, churches and community centers, Keeton said.

In the last few weeks, his staff has gotten feedback from MN4U readers that MCO members “are very confused and alarmed by the changes,” he said.

Most think they won’t have the option to stay with Passport, which has been the MCO provider in the region since 1995.

“Every single person can go back to Passport if they want to, but it’s not been made clear they can do that,” Keeton said.

About Medical News for You: Medical News for You is a 2-year-old montly publication designed to provide health care users with information to make better decisions and to spend treatment dolars more wisely. The paper is distributed to 1,400 physiucian offices and 80 health care locations around the Louisville area.